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CLINICAL ASPECTS
ENDODONTIC TREATMENT FAILURES
1C. BOITOR, 2ANCA FRIL, 3MONA IONAS, 4O. BOITOR
1,2,3Lucian Blaga University of Sibiu, 4Student Lucian Blaga University of Sibiu, Sibiu
Abstract: The causes of endodontic treatent failures
de!end on technical, biological or iatrogenic factors,"hich contribute to the acco!lishent of the treatent#
$no"ing and understanding the relation bet"een thesefactors ay hel! in increasing the chances of !reventing
the !ossible endodontic treatent failures#Keywords:endodontic treatents failures
Rezumat:%au&ele unor e'ecuri (n endodon)ie de!ind defactori tehnici, biologici sau iatrogeni care contribuie la
reali&area trataentelor endodontice# %unoa'terea 'i(n)elegerea cau&alit*)ii dintre ace'ti factori contribuie la
s!orirea 'anselor de !revenire a unor !osibile e'ecuri aletrataentelor endodontice
Cuvinte cheie:trataente endodontice, e'ecuri !osibile
The chances of curing the pulp affections requireendodontic treatment, which involves the removal of thepulp and root canal obturation. This might also be the
source of possible failures.A. Failure !ue "# "e$%&i$al rea#&.
In most cases, these are related to root canalanatomy and may be due to the following causes:
- Root variation in terms of shape and length are due tothe non topical dental morphology, or due to certain
root resorptions, short roots with large canals. Rootvariations inconveniencies may be overcome by
retroalveolar X-rays with needles in canals or by theelectronic measurement of the root length locator
ape!".- #dditional root, most of the times revealed only by
oblique radiography. $ouble canals, apicallybifurcated canals or even pulp diverticulum may be
detected on this occasion, as well.%"- &avity access with insufficient opening. The cavity
access should allow the surgeon to remove the
affected tissue, as well as to handle the instruments inthe best conditions. 'hen carrying out the access, we
should consider the location of canal holes, which
most of the times are mas(ed by hyper calcificationsand secondary dentine root filling. In order to
emphasi)e the opening of the root canal, we are
sometimes forced to use the colouring agents theyare more strongly retained by the soft tissues" orsodium hypochlorite*hydrogen pero!ide which
produce bubbles when they are in contact with
organic pulp substances".Root canal irrigation plays a (ey role in the
success of the endodontic treatment. This is obtainedthrough irrigation and mechanical removal of the root
canal contents and of the smear lear. In addition, there is achemical dissolving of the organic tissue, which depends
on the chemical composition of the irrigation substance.# good irrigation depends on the quantity of the solutions
used, on the antiseptic efficiency freshly preparedsolutions are more efficient" and also on the degree of
penetration of the antiseptic used. +owever, there is noideal irrigation solution, so the association of certain
complementary solutions is the most effective method.
The most recommended antiseptic solutions forendodontic lavages are: hydrogen pero!ide % vol.",
hypochlorite sodium %- vol.", clorhe!idine gluconatsolutions %-", /T#$ 0io 1ure 2olutions do!icylinhyclat , citric acid 3.45, .5 detergent Tween 6"
solutions containing chelating substances 7$T#, citricacid", which have the advantage of an easier penetration
of the canal, removing the remaining debris.4" &helatingsubstance can sometimes be at the origin of therapeutic
failures by creating false routes, using wrong methods. 0ythe use of the antiseptic substances, the efficiency of the
antibacterial treatment is increased8 it is suggested to usesodium hypochlorite, as the last substance used, because it
has a great power of neutrali)ing the traces of thechelating substances and of promoting a more al(aline
p+, which prevents bacterial multiplication."B. Failure !ue "# 'i#l#(i$al rea#&.
These failures are due to wrong mechanicaltraining or to a pure filling material.
The requirements of an ideal filling material arethe following:
- The antiseptic power should be longer8
- The material should not be irritating8- To provide three-dimensional tight closing8
- To be stable overtime8
- 7asy to handle and remove.0iological healing cement closure of the ape!"
can be prevented by a mechanical processing with a
diameter of more than .45 mm of the apical area. #shorter preparation over .5-% mm of the radiologicalape! can be a source of endodontic failure, because it may
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CLINICAL ASPECTS
leave in apical area, microorganisms, en)ymes or to!ins,
which lead in time to inflammatory lesions. 7!ceeding thelength of the root canal is another source of treatment
failure, because it prevents the canal drying, removing thepossibilities of biological healing. /oreover, it is a source
of irritation for the neighbouring tissues apicalperiodontium, sinuses and dental nerves".
In case of in9ures, which lead to thedisappearance of the apical constrictions, a limit in the
canal preparation is required, according to the clinical andradiological evaluation with the needle in the canal. In
practical terms, this is done manually or with rotary toolsand has as results, the creation of a bloc(ing cone.3,5"
The classical electronic method for measuringthe length of the root canal, based on the tactile sense of
the apical constriction, is considered today an empirical
and non efficient method. Radiography with needles incanal is considered more accurate, but it still has certain
shortcomings related to the phenomenon of paralla! andto the repeated e!posures to radiation, regarding thepatients.
The current electronic method for measuring thelength of the root canal based on the electrical potential
difference between the crown and dental ape!" is the mostprecise and has the most reduced side effects. This
method requires certain conditions for the accuracy ofresults, such as: filling removal or metallic micro
prosthesis from the e!amined tooth, choosing the rightdiameter channel instruments. This is not indicated to
peace-ma(ers bearers. There are clinical situations, suchas the presence of suppurate apical e!udates, calcium
hydro!ide on the root walls, or an impenetrable apicalforamen, which may bring about wrong results of the
canal length.
C. )eali&( *ailure #* $er"ai& +eria+i$al i&urie i&+i"e #* a& e&!#!#&"i$ $#rre$" "rea"-e&".
$esiderata of a right endodontic treatment
consist in the prevention of bacterial coloni)ation, the use
of a biocompatible material, tight and stable filling
overtime. $epending on the clinical situation, it issuggested that the endodontic treatment follow these
steps:- In absence of apical periodontitis canal obturation
should be done in one time phase8- In presence of apical parodontitis canal obturation
should be done in two times first time temporaryfilling with calcium hydro!ide and second time - the
final canal filling"$espite a proper endodontic treatment, the
occurrence and*or the persistence of periapical lesionsmay be due to certain diagnosis mista(es ;":
- 1eriapical infections in apical parodontitis case withsignificant osseous resorptions8
- Root fissures of fractures with hidden symptoms8- 0acterial flora persistence in undetected canals8
- 'ell-built ape! infections, under the form of a cystor abscess, which require surgical treatment8
- 1ersistence of foreign bodies in the apical area8
- &oronary deficit tightness, which may be the starting
point of certain bacterial infiltrations of the oralcavity towards the periapical space.
D. Failure !ue "# ia"r#(e&i$ rea#&.
The most common causes are the fractures of thesteel and nic(el-titanium endodontic instruments. In these
cases, retro alveolar X-rays in different incidences areindicated. #fterwards, it is suggested to intervene
surgically in order to remove the bro(en instruments. Theremoval protocol is to create an access way near the
fractured fragment, its lavage with sodium hypochloriteand chelating substances. +andy needles or needles
attached to an ultrasound tartar removal instruments 1ronowing the possible sources of endodontic
treatments failures must determine the dentist to adopt aproper treatment according to the technical equipment, so
that the patient should be safe from endodontic treatmentfailures.
'hatever the clinical situation would be, thepatient should be informed clearly about the treatment
possibilities and their prognostic.
REFERENCES%. 1ertot ' et all. ?a reprise du traitement
endodontique. @uintessence International 4;83;-A":%%-%3%.
4. 0u(iet B et all. =ptimiser lC antisepsie canalaire parune irrigation efficace. Real clin 4;8%D3"8D%-6.
. 2iquera EE et all. &hemo-mechanical reduction ofbacterial population in the root canal after
instrumentation and irrigation with %, 4.5 and5.45 sodium hypochlorite. E 7ndodont
484;;":%-3.3. 2iquera EE. 7ndodontic infections: concepts,
paradigms and perspectives. =ral 2urg =ral /ed=ral 1athol =ral Radiol 7ndod 448A3":35%-35D.
5. /artin $. Retrait des instruments endocanalairesfractures. Real &lin 4;8%D3":65-3.
;. &rinequette #.&. 2ituations dCechecs en endodontie &linique 46, hors serie, A-%D.
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